Is there a right place for prostitution? In 2006, Steve Wright murdered five women in Ipswich. All five of them had drug dependencies, and all were engaged in prostitution to fund their addiction. Wright was a punter – a regular, not obviously more violent than any of the men who picked up women on Ipswich’s streets. Even when the women were scared for their lives, they weren’t scared of Wright. “He was always a late person to come out, he would drive round a couple of times, then choose the girl he wanted,” Tracey Russell told the Guardian (her friend Annette Nicholls was Wright’s fourth victim). “We used to call them ‘window-lickers’ if they went around a lot. He was one of them. We didn't suspect him.”

At the time, one popular opinion on the murders was that the five women had died because they were in the wrong place – and that criminalisation had put them there. In a piece published here in the New Statesman, the English Collective of Prostitutes (ECP) blamed the law around prostitution, claiming that “women are being driven onto the streets by raids on premises where it is many times safer to work.” At the time, I was convinced that the five would still have been alive under different legislation. Looking back over the case, though, the facts don’t quite fit the ECP’s argument. Although one of Wright’s victims, Tania Nicol, had been forced out of massage parlours and on to the streets, she hadn’t been driven by raids: according to the manager of one of the parlours, she was asked to leave because of her drug use.

The women Wright killed weren’t “sex workers” pushed into harm’s way by illiberal limits on their “profession”; they were women with chaotic, fragile lives, pushed on to the frontier of male violence by their addictions. This was not a choice. (Russell described prostitution to the Guardian as “horrible”: “You learn to blank it out over the years, and because you are on drugs, [you] just think of something else. I know that sounds odd, but you do. ’Cos you get used to it, and it's over within seconds. Hopefully.”) Even if there had been a legal brothel in Ipswich, it seems unlikely that these five women would have been inside it.

And yet the argument that decriminalisation will make prostitution safe persists – in the UK, it’s policy for both the Liberal Democrats and the Green Party. What this “safety” for women would look like in practice is less discussed, but there is an example we can learn from just a few hundred miles away. Germany legalised prostitution in 2002, with the reasoning (as Nisha Lilia Diu reported for the Telegraph) that this would make prostitution “a job like any other”. Sex work as work, with contracts, benefits, workplace protections and none of the stigma that supporters of legalisation often claim is the ultimate source of harm to women in prostitution.

The German experiment didn’t go as planned: women (often migrants looking to score fast profits and get out of the country again) didn’t register for benefits, and the brothels that sprang up didn’t want to offer any contracts or risk any liability. Instead, brothel owners function more like landlords, charging the same cover fee for men to enter their premises and for women to work there, meaning a woman in prostitution won’t even start to make money till her second or third punter of the night. And what does she have to do to make that money? This week, Channel 4 documentary The Mega Brothel went inside the Stuttgart branch of the Paradise chain (yes, brothels in Germany have chains, like fast food joints or high street clothes shops) and interviewed the women, the punters and the brothel owner.

If you have any hopes that Paradise might be an Edenic scene of liberated sexuality, you should surrender them now. Early on, one of the punters explains his philosophy to the programme makers. “Sex is a service,” he says. “If you want to have good sex, you must pay good money for this service.” (The idea that “good sex” might involve respect, intimacy or mutuality has apparently not occurred to him: it is just a service, a thing performed by women for men, like doing the laundry or cleaning the house.) The interviewer asks a question: “What effect does that have on the girls themselves?” And the punter seems genuinely stumped. After a moment’s silence, he volunteers: “I don’t know, I never thought about it.”

It seems that a lot of the men don’t think about what they’re doing to the women they pay to have sex with. When Josie, who works as a prostitute at Paradise, shares the contents of her bag with the camera, she’s offering a dreary inventory of pain – experienced, anticipated and avoided. “I have a vibrator… a small one because sometimes men can be a little bit too aggressive, a little rough,” she explains. A medicinal-looking tube turns out to contain genital anaesthetic: “It’s like a small insurance if the pain is getting too big,” she says.

What kind of “work” can this be, where women have to numb their vaginas to tolerate penetration by men who don’t even think of the person penetrated as capable of feelings? Certainly not the kind of work that women are respected for doing. Michael Beretin, Paradise’s head of marketing, describes the women he lives off with maximal contempt: “These people are a totally fucked up, dysfunctional bunch of people. Very few of them have any soul left … It’s very sad but it’s what they are.” (This strange accountancy of the human essence echoes something said by the madam of a licensed Nevada brothel to Louis Theroux in the 2003 documentary Louis and the Brothel: “Every girl who’s really good at what she does gives away a little piece of her soul every time.”) The theory that stigma would evaporate on contact with legitimacy turns out to be nothing but fantasy, itself simmering into nothing once exposed to the real world.

In Germany, there are still pimps (the “loverboys” who pressure the women into the brothel and then skim their earnings). There are still traffickers, trying to get their human product into Paradise. There is still hate for the women. And fundamentally, there is still the raw brute fact of women being fucked for money, fucked sore, fucked as though they were not at home in their own bodies. Prostitution is violence against women, inflicted by men. The violence of being roughed up with a vibrator is less than the violence of being suffocated, but even having to draw that comparison is sickening. There is no “safe” here – when women’s bodies are made open for men’s use, we are simply disputing the boundary between “terrorised” and “dead”. Prostitution isn’t merely an occupation with some unfortunate but inevitable (male, violent) hazards to be ameliorated: it’s an institution that insists on the dehumanisation of women, the grinding away of our souls so we become easier to fuck, easier to use, easier to kill. Under sky or under ceiling, it’s the same. No one suspected Steve Wright. He was just another regular. The regulars are the problem.

Editor's Note, 9 February 2014: This piece originally referred to the fact that "Germany decriminalised prostitution in 2002". It should have been "legalised". This has now been corrected.

David had taken the same tablets for years. Why the sudden side effects?

David had been getting bouts of faintness and dizziness for the past week. He said it was exactly like the turns he used to get before he’d had his pacemaker inserted. A malfunctioning pacemaker didn’t sound too good, so I told him I’d pop in at lunchtime.

Everything was in good order. He was recovering from a nasty cough, though, so I wondered aloud if, at the age of 82, he might just be feeling weak from having fought that off. I suggested he let me know if things didn’t settle.

I imagined he would give it a week or two, but the following day there was another visit request. Apparently he’d had a further turn that morning. The carer hadn’t liked the look of him so she’d rung the surgery.

Once again, he was back to normal by the time I got there. I quizzed him further. The symptoms came on when he got up from the sofa, or if bending down for something, suggesting his blood pressure might be falling with the change in posture. I checked the medication listed in his notes: eight different drugs, at least two of which could cause that problem. But David had been taking the same tablets for years; why would he suddenly develop side effects now?

I thought I’d better establish if his blood pressure was dropping. I got him to stand, and measured it repeatedly over a period of several minutes. Not a hint of a fall. And nor did he now feel in the slightest bit unwell. I was stumped. David’s wife had been watching proceedings from her armchair. “Mind you,” she said, “it only happens mid-morning.”

The specific timing made me pause. I asked to see his tablets. David passed me a carrier bag of boxes. I went through them methodically, cross-referencing each one to his notes.

“Well, there’s your trouble,” I said, holding out a couple of the packets. One was emblazoned with the name “Diffundox”, the other “Prosurin”. “They’re actually the same thing.”

Every medication has two names, a brand name and a generic one – both Diffundox and Prosurin are brand names of a medication known generically as tamsulosin, which improves weak urinary flow in men with enlarged prostates. Doctors are encouraged to prescribe generically in almost all circumstances – if I put “tamsulosin” on a prescription, the pharmacist can supply the best value generic available at that time, but if I specify a brand name they’re obliged to dispense that particular one irrespective of cost.

Generic prescribing is good for the NHS drug budget, but it can be horribly confusing for patients. Long-term medication keeps changing its appearance – round white tablets one month, red ovals the next, with different packaging to boot. And while the box always has the generic name on it somewhere, it’s much less prominent than the brand name. With so many patients on multiple medications, all of which are subject to chopping and changing between generics, it’s no wonder mix-ups occur. Couple that with doctors forever stopping and starting drugs and adjusting doses, and you start to get some inkling of quite how much potential there is for error.

I said to David that, at some point the previous week, two different brands of tamsulosin must have found their way into his bag. They looked for all the world like different medications to him, with the result that he was inadvertently taking a double dose every morning. The postural drops in his blood pressure were making him distinctly unwell, but were wearing off after a few hours.

Even though I tried to explain things clearly, David looked baffled that I, an apparently sane and rational being, seemed to be suggesting that two self-evidently different tablets were somehow the same. The arcane world of drug pricing and generic substitution was clearly not something he had much interest in exploring. So, I pocketed one of the aberrant packets of pills, returned the rest, and told him he would feel much better the next day. I’m glad to say he did.